CRYPTOCOCCUS-NEOFORMANS VERTEBRAL OSTEOMYELITIS

A 67-year-old previously healthy woman presented with low back pain of 2 months duration and daily fever of 39-degrees-C for 3 weeks. CT sca n showed a lytic lesion in the third lumbar vertebra and a small right lower lobe lung infiltrate with mediastinal lymphadenopathy. Culture of material obtained from open biopsy of the vertebra grew Cryptococcu s neoformans var. neoformans, which was also demonstrated on histology . Cryptococcal antigen was detected in the patient's serum. Treatment with amphotericin B (1000 mg total dose) and oral 5-fluorocytosine, re sulted in complete recovery and resolution of the chest X-rav findings with a follow-up of 2 years. Since this case, as well as most of the previously described cases of cryptococcal osteomyelitis, were in norm al hosts, cryptococcal osteomyelitis should be considered in the diffe rential diagnosis even in a normal host, and therefore, prior to possi ble invasive diagnostic procedures, cryptococcal antigen in the serum should be determined.